Key Points
ÎThromboembolic complications of valvular heart disease are often devastating.
ÎAntithrombotic therapy can reduce the risk of thromboembolism, but at the cost of increased bleeding.
Treatment Rheumatic Mitral Valve Disease
ÎIn patients with rheumatic mitral valve disease and normal sinus rhythm (NSR) with a left atrial diameter < 55 mm, the American College of Chest Physicians (ACCP) suggests NOT using antiplatelet or vitamin K antagonist (VKA) therapy (2-C).
ÎIn patients with rheumatic mitral valve disease and NSR with a left atrial diameter > 55 mm, the ACCP suggests VKA therapy (target international normalized ratio [INR] 2.0-3.0) over no VKA therapy or antiplatelet (2-C).
ÎFor patients with rheumatic mitral valve disease complicated by the presence of left atrial thrombus, the ACCP recommends VKA therapy (target INR 2.0-3.0) over no VKA therapy (1-A).
ÎFor patients with rheumatic mitral valve disease complicated singly or in combination by the presence of atrial fibrillation or previous systemic embolism, the ACCP recommends VKA therapy (target INR 2.0-3.0) over no VKA therapy (1-A).
Asymptomatic Patent Foramen Ovale, Atrial Septal Aneurysm or Cryptogenic Stroke
ÎIn patients with asymptomatic patent foramen ovale (PFO) or atrial septal aneurysm, the ACCP suggests NOT using antithrombotic therapy (2-C).
ÎIn patients with cryptogenic stroke and PFO or atrial septal aneurysm, the ACCP recommends aspirin (50-100 mg/d) over no aspirin (1-A).
ÎIn patients with cryptogenic stroke and PFO or atrial septal aneurysm who experience recurrent events despite aspirin therapy, the ACCP suggests treatment with VKA therapy (target INR 2.0-3.0) and consideration of device closure over aspirin therapy (2-C).
ÎIn patients with cryptogenic stroke and PFO, with evidence of deep venous thrombosis (DVT), the ACCP recommends VKA therapy for 3 months (target INR 2.0-3.0) (1-B) and consideration of device closure over no VKA therapy or aspirin therapy (2-C).
